Abstract YO35
Case summary
A 77-year-old man was referred to the medical oncology service because he presented with a mass and swelling of the left side of his face which he first noticed 6 months earlier. There was a gradual increase in size of the mass. Ultrasound showed a 4.36 x 2.42 x 4.09 cm solid mass, well circumscribed, heterogeneously hypoechoic within the left parotid gland. On physical examination, the patient had a large, exophytic, fungating mass at the left facial area with swelling of the surrounding tissue and the left periorbital areas (Figure 1A and B).
His medical history included a previous treatment of non-Hodgkin’s lymphoma, diffuse large B cell type 6 years ago and was treated with six (6) cycles of R-CHOP (rituximab + cyclophosphamide, doxorubicin, vincristine and prednisone). The patient completed the treatment but was unable to follow-up.
The patient was apprised for second line treatment with Bruton’s tyrosine kinase (BTK) inhibitors but was unable to secure it due to limited finances. The patient underwent chemotherapy with R-GemOx (rituximab 375m/m2 on day 1+ gemcitabine 1,000mg/ m2 on day 1 + oxaliplatin 100mg/m2 on day 1 every 21 days) for six (6) cycles and was noted with gradual decrease and resolution of the previously noted mass.
End of treatment was consistent with a complete metabolic response with FDG PET/CT scan done three (3) months after the first scan (Figure 3C and 3D) showing a marked regression in size of the lobulated soft tissue enhancing mass in the left lateral neck, involving the left parotid, masticator and buccal spaces measuring 6.9 x 1.8 x 6.3 cm with a FDG uptake (SUVmax 1.6, Deauville score 2). The previously noted enlarged lymph nodes on the left lateral neck have also markedly regressed with the largest measuring 0.8 cm at the level V with FDG uptake (SUVmax 0.9, Deauville score 1). There was no evidence of new metabolically active nodal disease.